Self-help therapy for insomnia: a meta-analysis.
BACKGROUND
Insomnia is a prevalent problem which often leads to a reduced quality of life and diminished work productivity. Only a minority of patients are treated with effective non-pharmacological therapies. A self-help intervention might offer an inexpensive and more accessible alternative to face-to-face treatment.


METHODS
We conducted a meta-analysis of randomized controlled studies examining the effects of self-help interventions for insomnia, identified through extensive searches of bibliographical databases. We examined the effects of self-help on different sleep outcomes, in comparison with both waiting lists controls and face-to-face treatments.


RESULTS
Ten studies with a total of 1000 subjects were included. The intervention did improve sleep efficiency (d=0.42; p<0.05), sleep onset latency (d=0.29; p<0.05), wake after sleep onset (d=0.44; p<0.05) and sleep quality (d=0.33; p<0.05) but not total sleep time (d=0.02; p>0.05). The sleep improvements were maintained over the longer term. Symptoms of anxiety and depression also decreased after self-help (d=0.28; p<0.05 and d=0.51; p<0.05, respectively). Although based on a very limited number of studies, the face-to-face treatments did not show statistically significant superiority to the self-help treatments. The effect sizes associated with self-help treatments might be overestimated due to publication bias.


CONCLUSIONS
The effects of self-help treatments are small to moderate. Nevertheless, they might constitute a useful addition to existing treatment options especially when integrated in a stepped care approach.
van Straten
Annemieke
A
Vrije Universiteit Amsterdam, FPP, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. p.cuijpers@psy.vu.nl
Cuijpers
Pim
P
D001007:Anxiety / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003863:Depression / Q000523:psychology / Q000628:therapy; D006970:Disorders of Excessive Somnolence / Q000523:psychology / Q000628:therapy; D006801:Humans; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods* / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome